In the line of work that Dotan Herszage is in, a few tears, some blood and the occasional fainting spell are all part of the job.
As a mohel, Herszage, of Columbus, Ohio, has traveled the Midwest performing circumcisions for 23 years.
Among Jewish people, the removal of a baby's foreskin is done as part of a ceremony when the child is 8 days old. Herszage, 50, estimates he's done about 10,000 of the procedures.
"It's a sign that God gave us," Herszage said. "It's a sign of a commitment. So the bris is extremely important to us in the sense that you really don't enter the realm of the Jewish people until that's done."
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Without a bris, a Jewish person typically can't have a bar mitzvah, a Jewish wedding or be buried in a Jewish cemetery.
"Several times it's happened to me that a person dies who was Jewish, for some reason or another, wasn't circumcised," he said. "And before we bury them, we do bris on the person."
The fainting spells are typically from the fathers, not the babies, he said. The procedure involves a topical anesthetic, and Herszage said he's never had a baby experience medical problems as a result.
"I think men relate to it a lot more," Herszage said of fathers fainting. "And also the fact that women usually leave the room. They don't want to be part of it, so they leave the room."
Last month, Herszage was at B'nai Jacob Synagogue, in Charleston, performing a bris for Caleb Leven, the son of David and Avrah Leven and grandson of Rabbi Victor and Marilyn Urecki.
Herszage, whose family owns a pawn shop in Columbus, learned the trade from his father, also a mohel.
"Usually it is a lineage thing, father to son kind of thing," he said. "Every once in a while you'll get the ones that just really want to become a mohel, but in my case my father was a mohel."
Besides his father's training, Herszage also trained with a urologist and at a hospital in Israel. Herszage said the procedure isn't regulated by a medical or government board.
"This kind of falls under a religious practice," he said.
The bris ceremony has four parts: prayers, the procedure itself, naming the child and a meal for those gathered the ceremony.
"There's always a festive meal, that's why you don't see very many skinny Jewish people," Herszage joked.
Herszage does the ceremony for gentile families as well. When he left the ceremony at B'nai Jacob late last month, he was headed to do the procedure for an Amish baby.
"I've done Muslims," he said. "(With) Muslims, it's also pretty common, the Amish, you have a lot of evangelicals, anything. There's no rhyme or reason, just basically whoever calls me, whoever needs me."
He does the occasional adult convert to Judaism, too. The procedure is different for grown men who were circumcised as babies but didn't go through a Jewish bris.
"If a person wants to be Jewish and is already circumcised, then what we do is we draw blood from that area," he said. "Because it's a blood pact. So circumcision is not only the removal of the foreskin, it's not only a sign."
Urecki said he's always thought the eighth day is significant because according to the creation story, the world was made in seven.
"That's God's world, if you will," Urecki said. "On the eighth day, we take over. We improve the world, if you will. We do things to the world. We impact the world, and so the child is now ours. The first seven days this child is God's child. And now it's the parents responsibility to raise them in a relationship with God, and the ceremony for us is the circumcision."
Outside of a religious ceremony, circumcision is a common procedure among American males. The number of the procedures has declined in recent years, according to the U.S. Centers for Disease Control and Prevention.
"It really is a very controversial issue," Herszage said.
According to the CDC. circumcision helps prevent urinary tract infections in infants and HIV and other sexually transmitted infections in heterosexual adult males.
A Netflix documentary released last year questioned the health benefits of the practice and compared it to female genital mutilation.
Herszage said people frequently ask him to convince them circumcision is necessary. But he's not a salesman, he said.
"You want one, I'll be glad to do it for you," he said. "If you are willing to take the responsibility of taking care of (the foreskin) then there's really no reason to do it."
He said in his observation, many men will need such a procedure in their lifetime, for one reason for another.
"Obviously, at a later age, it's much more than a procedure and you could be laid up for quite a bit the older you are," he said.
Rabbi Urecki said that, for Jewish people, the health benefits or risks don't play much of a factor.
"It's there for us to be able to wed the story with the experience, but we're not doing it thinking, 'This is beneficial to the child,'" Urecki said of circumcision. "What it's doing is connecting this child to his family, to his generations."